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Issues Posing a Threat to a Successful ASC Billing

June 06, 2016

Ambulatory Surgical Centers (ASC), also known as outpatient surgery centers or same day surgery centers are those healthcare facilities where less complicated surgeries that do not require an overnight stay are performed. Like others, ASC centers too are subjected to the turbulent healthcare industry along with posing some major threats to a successful billing and coding practice. Some of the major threats to ASCs are mentioned below:

Reimbursements: ASCs need to educate patients on such centers being cheaper than hospitals; along with patients having the options for deductibles and co-pays. As insurance providers have not been providing annual reimbursement increases, they make it tough for ASCs to work out-of-network due to certain policy changes. Procedure bundling and payment cuts in case of high-cost implants are also creating lower reimbursements for ASCs.

Employment: Many physicians are joining hospitals more than ASCs which is a major concern as it hinders the growth of ASCs. Merging of two surgery centers can reduce fixed costs and be more cost-effective and commercially viable.

Saturation: Oversaturation is sinking in the ASC industry. On one hand, ASCs use only a part of their facility and are underperforming; but due to tapering reimbursements, it is becoming increasingly important for them to associate with a health care center. They must increase efficiencies and work towards standing out in the competition.

Dominance: Hospitals are striving to dominate and create a monopoly, slowly edging out ASCs from the market. Due to referrals from hospitals, patients go back to a hospital rather than visiting ASCs (cutback on patients). Again, ASCs can look at merging with hospitals for better physicians and reimbursement rates.

Mismanagement: To avoid mismanagement, ASCs need to have updated risk management, clinical and business systems, along with excellent payer negotiations for the finest reimbursement rates. ASCs should benchmark against other centres to identify and overcome shortcomings.

Regulations: Due to hostile financial strategies used by some ASCs, they attract harsh regulations which authentic ASCs have to endure.

Uncertainty: Due to the 'Affordable Care Act,' ASCs are under threat. Even though they can attract more patients, the financial liability of patients being unaware about high deductibles and ASCs being responsible for collecting a large portion of the bill rests with them.

Financial responsibility (patient): If the financial responsibility on the patient increases, it will lead to bad debts and higher number of days for accounts receivables. Hence certain procedures must be carried out such as: calculating patients' financial responsibility and explaining it to the patient before the service, collecting the entire amount or the minimum threshold and describing the post-date of service balance collection activities. ASCs need to verify contracts and all insurances while contacting payers on a timely basis for getting payments issued.

Staff: Business can suffer if the staff only accepts payments from insurance, simultaneously leaving a lot on the table. To combat this, ASCs need to measure the quality of production and communicate the expectations, give feedbacks and proffer incentives and bonuses.

Payments and technology: Revenue cycle can be affected if the staff is unaware of billing and coding rules. Lack of documentation and inappropriate coding leads to denials. Experienced staff should work efficiently towards understanding payer expectations and complexities that might make ASCs lose revenues (e.g. bundled payments). ASCs should keep technology updated in comparison with hospitals to acquire patients for treatment.

With acute cases shifting to ASCs, they can look towards good financials. But this will only be possible if all payment mechanisms can be handled along with eliminating erstwhile problems.

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